WELCOME TO ALL FELLOW CAMPAIGNERS for DISABILITY RIGHTS - a pan disability blog connecting my work with, EQUAL LIVES, the National Survivor User Network (NSUN) and the Survivor History Group.

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Sunday, 9 May 2010

Do We Know Us?

The pearl of the Brown government’s ‘Improving Access to Psychological Therapy’ policy: ‘cognitive behavioural therapy (CBT)’ appears to be on the way to being proven to be a just-scratch-the-surface method of treatment.

“...the idea that all cognitive and behavioural can be carried out in the absence of consciousness” is called ‘conscious inessentialism’ and is a red herring according to Anil K Seth, co-Director of the Sackler Centre for Consciousness Science.

I find this a fascinating and exciting development. The Sackler Centre for Consciousness Science at the University of Sussex http://www.sussex.ac.uk/sackler/index is brand new having been officially opened only on 21st April of this year. Combined, as one strand, in their studies and research are neurophysiology and psychiatry. For instance, they are beginning to look at the kinds of separations from reality which are part of schizophrenia and other mental impairments with a good deal of progress in unravelling what the unconscious and conscious processes are - real hope for future treatment here.

I came across the Sacler Centre via an article in today’s Observer Review section entitled “The Search for Consciousness” by Anil Seth. This is a really good introduction to the intricacies of the work. However what sparked my interest most was the statement:

  • “A hundred years ago, consciousness was at the heart of psychology, and it was only excluded following the advent of behaviourism, which focussed scientific efforts only on what could be observed objectively - behaviour, not experience. But now we recognise it’s OK to take people’s descriptions of their conscious experiences as proper scientific data.”

In our work on IAPT at Norfolk LINk we have encountered a good deal of concern over the only ‘Access to Psychological Therapy’ available being CBT, and the stated reason for this is that it is the only psychosocial therapy that is an ‘evidenced practice’ and the only one authorised by NICE, the National Institute for Clinical Excellence (others say it is the only one available because it’s the cheapest!).

One of the things consciousness science seems to be implying is that dynamic forms of psychosocial therapy such as Rogerian counselling, transactional analysis and, of course, psychoanalysis are not as evidentially defunct as the powers that be, and the scientific community have been claiming. Perhaps this is a route towards better patient choice in IAPT - that is if whoever gets a government together continues to pursue the policy.

Whatever, the future of psychosocial therapy is going to be interesting.


Anonymous said...


You allude to some anonymous and distant ' powers that be' as positioning CBT as a replacement for other forms of therapy when the charities behind NSUN and Mind relentlessly pushed CBT as well.

Here's part of a letter to an OCT from a local Mind group . At the time the funding for all this centre's non CBT therapies was being pulled National Mind was coming in behind the DoH CBT roll out demanding that all therapies be better regulated by Government and offered around a similar scientific evidence base to CBT. In other words, National Mind wasat complete odds with local Mind branches and service users.

"Despite strenuous efforts to understand the rationale and process behind the decision to
focus the provision of talking therapies in primary care exclusively on delivering cognitive
behaviour therapy (CBT) based interventions it is still unclear why the PCT is no longer
prepared to commission counselling.

Our adult counselling service will close at the end
of March 2010.

Our centre and a
not-for-profit organisation providing GP counselling in the locality remained as two of the partners on the Primary Care Mental Health Development Board.
This board has had oversight of the development of our project and in addition had
a remit from commissioning to design the optimum configuration for psychological
services in area. This was to include CBT, counselling and secondary mental health services.

Despite this work being well advanced, and with no prior discussion or consultation,
providers were informed in October 2009 that the provision of counselling was to be
removed from the county.

Impact on Service Users

The decommissioning of counselling will leave a significant gap in the availability of
talking therapies in primary care and will remove patient choice as only CBT based
therapies will be available through the Healthy Minds service.

With nothing commissioned to replace counselling there will be no alternative in primary care for
patients who are not suitable for CBT.

CBT is an effective therapy but not suitable for all conditions. Clients with symptoms of
anxiety or depression (depending on the severity) will explore through CBT the problems
they are experiencing within the context of the ‘here and now’, focusing on behaviour
and negative/irrational thoughts. It acknowledges the influence that past issues have on
the present but does not spend time exploring the past with the client to allow them to
gain insight into their state of mind.
The majority of the clients using our counselling services have issues resulting from
childhood experiences, childhood trauma, the environment they grew up in/are living in,
relationships, interpersonal difficulties, attachment disorders, issues around
abandonment or sexual abuse. Many of these people would fall outside of the criteria
for Healthy Minds.

In concentrating on the value of the relationship between client and
therapist, counselling aims to work through these often painful issues so clients can
understand why they feel as they do or have behaved as they have"

This is pretty shameful stuff , service users aren't being represented through NSUN at all .

Anonymous said...

This is very interesting as I have thought that cbt is not all what it cracked up to be for a long while

micox said...

The first anonymous commentator seems not to have read the posting. The central theme is the new research into consciousness. CBT is only mentioned to show how limited it is in the context of this new research. My own opinion is that the government by (powers that be) pushing CBT in IAPT is misled by the NICE position on 'evidence based' therapy.

There is certainly nothing about NSUN there and I suspect the person hidden behind the anonymity is someone I know who has a silly obsession about organisations like NSUN following illicit practices.




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